Owner Relinquish

PLEASE NOTE: By submitting this form, Last Hope Animal Rescue is not committing to assisting with the placement of your animal. We gather information, and may follow up with additional questions or request pictures or documentation to better understand your animal and their needs, while we work to find a volunteer foster home to assist. We do have a waiting list for animals to join our care, and encourage you to consider speaking to your veterinarian or a trainer for medical or behavioral concerns an animal may be exhibiting.

Email communications from Last Hope Animal Rescue may hit your spam/junk folder, please be sure to check here for messages before reaching out to follow up on the status of your relinquish request.

Contact Information

First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
-

County

Email*

Home Phone

Work Phone
x

Cell Phone

Alt Email

*=required

Animal's Name*

Species*

Animal's age*

Breed*

Sex*

Animal's Weight (In pounds)*

Where or how was the animal originally acquired?*

Is the animal housetrained?*

Veterinarian Name*

Veterinarian Address*

Veterinarian City*

Veterinarian Phone*

Is the animal spay/neutered?*

Date of last Rabies Vaccination

Date of last Distemper vaccination

Date of last Bordetella (kennel cough) vaccination

Date of last heartworm test

Results of last heartworm test

Is the animal currently on heartworm preventative?

Date that heartworm preventative was last given

Is the animal currently on flea/tick preventative?

Date the animal was last given flea/tick preventative

What brand food and amount does the animal eat each day?

Is the animal used to a fenced in yard? Tie out? Other?

Where does the animal sleep?

Where is the animal when you are away from home?

Is the animal used to being in a kennel or crate? For how long?

How does the animal react to small children? (detailed answer)

Hows does the animal react to older children, men and/or women? (detailed answer)

What is the animal afraid of? (detailed answer)

Reaction to new people

Hows does the animal react to dogs? (detailed answer)*

How does the animal react to cats?*

Does the animal have a bite history?*

If the animal has a bite history, describe the incident(s), the person(s) or other animal bit, number of incidents, etc (detailed answer)

Reason for surrendering animal (detailed answer)*

*=required